David Healy follows his widely praised study, The Antidepressant Era, with an even more ambitious and dramatic story: the discovery and development of antipsychotic medication. Healy argues that the discovery of chlorpromazine (more generally known as Thorazine) is as significant in the history of medicine as the discovery of penicillin, reminding readers of the worldwide prevalence of insanity within living memory.
But Healy tells not of the triumph of science but of a stream of fruitful accidents, of technological discovery leading neuroscientific research, of fierce professional competition and the backlash of the antipsychiatry movement of the 1960s. A chemical treatment was developed for one purpose, and as long as some theoretical rationale could be found, doctors administered it to the insane patients in their care to see if it would help. Sometimes it did, dramatically. Why these treatments worked, Healy argues provocatively, was, and often still is, a mystery. Nonetheless, such discoveries made and unmade academic reputations and inspired intense politicking for the Nobel Prize.
Once pharmaceutical companies recognized the commercial potential of antipsychotic medications, financial as well as clinical pressures drove the development of ever more aggressively marketed medications. With verve and immense learning, Healy tells a story with surprising implications in a book that will become the leading scholarly work on its compelling subject.
Prozac on the Couch traces the notion of “pills for everyday worries” from the 1950s to the early twenty-first century, through psychiatric and medical journals, popular magazine articles, pharmaceutical advertisements, and popular autobiographical "Prozac narratives.” Metzl shows how clinical and popular talk about these medications often reproduces all the cultural and social baggage associated with psychoanalytic paradigms—whether in a 1956 Cosmopolitan article about research into tranquilizers to “cure” frigid women; a 1970s American Journal of Psychiatry ad introducing Jan, a lesbian who “needs” Valium to find a man; or Peter Kramer’s description of how his patient “Mrs. Prozac” meets her husband after beginning treatment.
Prozac on the Couch locates the origins of psychiatry’s “biological revolution” not in the Valiumania of the 1970s but in American popular culture of the 1950s. It was in the 1950s, Metzl points out, that traditional psychoanalysis had the most sway over the American imagination. As the number of Miltown prescriptions soared (reaching 35 million, or nearly one per second, in 1957), advertisements featuring uncertain brides and unfaithful wives miraculously cured by the “new” psychiatric medicines filled popular magazines. Metzl writes without nostalgia for the bygone days of Freudian psychoanalysis and without contempt for psychotropic drugs, which he himself regularly prescribes to his patients. What he urges is an increased self-awareness within the psychiatric community of the ways that Freudian ideas about gender are entangled in Prozac and each new generation of wonder drugs. He encourages, too, an understanding of how ideas about psychotropic medications have suffused popular culture and profoundly altered the relationship between doctors and patients.
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